Novo Nordisk (NOVOb.CO) shares took another hit on Thursday as the world’s top maker of diabetes drugs disappointed investors with a lower 2017 sales and profit growth forecast due to price pressure and U.S. political uncertainty.

The Danish company has long benefited from its focus on diabetes, as cases of the disease have soared worldwide, but increased competition is squeezing U.S. prices, pharmacy purchase managers are demanding bigger discounts and U.S. patients suing over alleged industry price fixing.

“We are looking at a more volatile environment and we see that the political system in the U.S. is less predictable than perhaps ever,” Lars Fruergaard Jorgensen, who took over as CEO on Jan. 1, told Reuters.

U.S. President Donald Trump called on pharmaceuticals companies on Tuesday to make more of their drugs in the United States and to cut “astronomical” prices, while vowing to speed approval of new medicines and ease regulation.

Novo Nordisk acknowledged that its U.S. business, which accounted for 53 percent of total 2016 revenues, fell short.

“What we haven’t delivered on is related to market access. We haven’t had a sufficiently positive sales development,” CFO Jesper Brandgaard told Reuters.

Novo aims to focus its sales force and improve partnerships with large pharmacy benefit managers, who administer drug benefits and negotiate rebates for employers and health plans.

“It is important that we focus on possibilities where we gain costumers from other drugs,” he said, adding that the uptake of its new long-acting insulin Tresiba in 2016 had been too much at the expense of an older Novo drug.

France’s Sanofi (SASY.PA) has also felt the heat, but its large stable of non-diabetes medicines has been a buffer.

REGAIN CONFIDENCE

The U.S. headache adds to the challenge the new chief, who began his Novo career more than 25 years ago as a graduate, faces to restore investor trust after it cut its long-term operating profit outlook twice in just nine months.

“Changing long term guidance two times within a year was not a good job and clearly the management did underestimate in the U.S. the pricing risk,” Jean Medecin of Carmignac, Novo’s seventh-biggest investor, said.

Shares in Novo are down around 40 percent since the firm cut its long-term growth target for the first time last year.

“(Investor confidence) is something I will have a great emphasis on… We have to deliver on what we have promised,” Fruergaard said.

Novo now forecasts 2017 sales growth of between minus 1 and plus 4 percent, and operating profit of minus 2 percent to plus 3 percent growth in local currencies.

The group’s shares fell by more than 5 percent, making it the second-biggest faller in the STOXX 600.

“It (the 2017 outlook) is received (as) more dramatic than it really is… We don’t see a different market and we are quite comfortable that we can deliver what we’ve said earlier,” Fruergaard said of the share price reaction.

The company had previously expected low single-digit sales growth and flat to low single-digit operating profit growth in local currency terms. Growth reported in Danish crowns is expected to be around 2 percentage points higher than the local currency level, it said.

Fourth-quarter operating profit rose 1 percent on the year to 11.2 billion Danish crowns ($ 1.62 billion) on revenue of 29.6 billion crowns, below an average 11.4 billion crowns forecast in a Reuters poll of analysts.